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» LymeNet Flash » Questions and Discussion » Medical Questions » do I have a pre-existing condition if I don't meet CDC guidelines for blood testing ?

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Author Topic: do I have a pre-existing condition if I don't meet CDC guidelines for blood testing ?
Karensky
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...since the CDC guidelines consider my blood results as negative

for lyme disease... then...I do not have a pre-existing

condition...correct ?!

[loco] [loco] [loco] [loco]

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"Gratitude is not only the greatest of virtues , but the parent of all others "....Cicero

Posts: 254 | From new jersey | Registered: Jul 2009  |  IP: Logged | Report this post to a Moderator
wtl
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I am afraid the insurance companies will base this on your treatment, not diagnosis.

Time to press the congress to pass a legislation that's overdue to the great people of this nation.

Posts: 822 | From midwest | Registered: Apr 2009  |  IP: Logged | Report this post to a Moderator
Lymetoo
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Legislation won't help.

I would think treatment would pose a problem, as wtl says.

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--Lymetutu--
Opinions, not medical advice!

Posts: 94590 | From Texas | Registered: Feb 2001  |  IP: Logged | Report this post to a Moderator
Leelee
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I don't know for sure, but my guess is you would be considered to have a pre-existing condition b/c a doctor has presumed you have Lyme and is treating you for it.

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The ultimate measure of a man is not where he stands in moments of comfort and convenience, but where he stands at times of challenge and controversy. Martin Luther King,Jr

Posts: 1573 | From Maryland | Registered: Feb 2009  |  IP: Logged | Report this post to a Moderator
Aniek
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Pre-existing conditions are different in group insurance (like employer insurance) and on the individual market.

If you have ERISA covered insurance (through your employer, union, etc.) then a pre-existing condition is defined as condition for which you have received a diagnosis or treatment within the past 6 months. Having had the medical test for the symptoms you have would probably make it a pre-existing condition. But, they might not catch it if you don't have the diagnosis.

If you have insurance through the individual market, then pre-existing condition is defined by the insurance company and generally, if you have the symptom, it is pre-existing. In fact, most insurance companies would say it was pre-existing from the day you were bitten. So if you were bitten by a tick in March, purchased insurance in April, and came down with Lyme symptoms in May, the insurance company would say it was pre-existing if they knew about it, whether or not you knew you were sick.

I know of cases where individual insurance denied treatment for cancer because the tumor would have had to have been pre-existing at the time the insurance was purchased for it to grow to the size it was when detected.

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"When there is pain, there are no words." - Toni Morrison

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Maryland Mom
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Aniek brings up many good points.

If your Lyme is considered a pre-existing condition (and as others have said, it probably is), it will be much easier to get around that if you have group insurance.

Some group insurance plans have six month waiting periods for pre-existing conditions.

If you have recently changed insurance though, but had coverage through another company for eighteen consecutive months with your prior insurer, that would negate the pre-existing condition clause. Your prior insurer should have sent you a certificate of coverage after your coverage with them ended if this was the case.

In that situation, if your new insurer tries to deny a claim due to it being a pre-existing condition, just send your insurance company a copy of your certificate of prior coverage, and they should pay your claim.

Posts: 962 | From Charleston | Registered: Jan 2002  |  IP: Logged | Report this post to a Moderator
Karensky
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It is an interesting conundrum ...

which is why the hearings on the 30th were very important...

the outcome of which we have yet to see...but it is a step in the right direction...

on a personal note...

I think I will spend my own $$$'s for the meantime...chasing after insurance at this point seems like a waste of some very valuable time and energy...which I don't have much of...energy that is... [Wink] [Wink] [Wink]

...and there would most likely be a waiver in the policy anyway...

thanks for the feedback...it has confirmed my thinking on the subject...
[group hug] ...you guys/gals are such a help... [Smile]

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"Gratitude is not only the greatest of virtues , but the parent of all others "....Cicero

Posts: 254 | From new jersey | Registered: Jul 2009  |  IP: Logged | Report this post to a Moderator
   

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